NPIMap

Organization Active NPI

Active Life Health of Cincinnati LLC

  • Physical Medicine & Rehabilitation Physician
  • Cincinnati, OH
National Provider Identifier
1417513193
Registry record updated May 17, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
Legal business name
ACTIVE LIFE HEALTH OF CINCINNATI LLC
Practice address
8251 Pine Rd Ste 205
Cincinnati, OH 45236-2191
Phone
(513) 904-5888
Fax
(513) 904-5867
NPI assigned
May 17, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 17, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
John Rush, MDNPI 1851337281
Title
Owner
Phone
(301) 928-1697

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208100000X Primary

Addresses

Primary practice location

8251 Pine Rd Ste 205
Cincinnati, OH 45236-2191

Mailing address

PO Box 79662
Baltimore, MD 21279-0662
Phone (513) 904-5888

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20190718001900 OH Part B Supplier - Clinic/Group Practice 4183959745 Receives reassigned benefits from 15 practitioners
Practice locations: Cincinnati, OH
O20191121000198 OH DME Supplier - Physician - General Practice 4183959745 Practice locations: Cincinnati, OH

National Provider Directory

National Provider Directory
Tax ID family
Active Life Health of Cincinnati LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

8251 Pine Rd
Ste 210
Cincinnati, OH 45236
Phone (513) 419-4158

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 17

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1558051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1558051200000",
    "number": "1417513193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 79662",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212790662",
            "telephone_number": "513-904-5888",
            "fax_number": "513-904-5867"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8251 PINE RD STE 205",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452362191",
            "telephone_number": "513-904-5888",
            "fax_number": "513-904-5867"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVE LIFE HEALTH OF CINCINNATI LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-17",
        "last_updated": "2019-05-17",
        "status": "A",
        "authorized_official_last_name": "RUSH",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "301-928-1697",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cincinnati, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.